Bicarbonate versus acetate hemodialysis in ventilated patients

Hemodynamic tolerance to bicarbonate versus acetate hemodialysis was studied in seven ventilated, critically ill patients, suffering from acute renal failure. Both kinds of hemodialysis were carried out with a recirculating dialysate delivery system and a relatively low blood flow (180 ml/min). Each patient underwent two hemodialysis procedures, one with bicarbonate and one with acetate, lasting for four hours. Ultrafiltration rates were kept below 250 ml/h and only biocompatible membranes with a relatively small surface area (Biospal 2400, Hospal, France) were used. Despite the mild hemodialysis conditions, hypotensive episodes with a mean blood pressure below 70 mmHg were observed in 3 out of 7 bicarbonate sessions and 4 out of 7 acetate sessions. Thus, we could not demonstrate a hemodynamic advantage of bicarbonate hemodialysis in this group of ventilated patients. This contrasts with other studies conducted in non-ventilated patients. Prevention of hypoxemia by mechanical ventilation and control of vascular tone by the use of vasoactive drugs may be of more clinical relevance than the kind of hemodialysis procedure that is used.